Physicians' Opioid Prescribing Practices and Their Impact on Long-Term Opioid Use

Long-term opioid use increases the danger of misuse, addiction and
even overdose, fueling what public health experts have called a national
epidemic of opioid overuse. In 2015, more than 15,000 people in the
United States died from an overdose involving prescription opioids,
according to the Centers for Disease Control and Prevention.

Physicians' Opioid Prescribing Practices and Their Impact on Long-Term Opioid Use

Emergency room patients treated by physicians who prescribe opioids
more often are at greater risk for long-term opioid use even after a
single prescription than those who see less-frequent prescribers, suggested the findings of a study from Harvard Medical School and
T.H. Chan School of Public Health.

‘Emergency room patients treated by physicians who prescribe opioids more often are at greater risk for long-term opioid use even after a single prescription than those who see less-frequent prescribers.’

The research, believed to be the first to measure variation in
provider prescribing practices and their impact on long-term opioid use,
is published in the New England Journal of Medicine.

The findings, the researchers add, underscore an acute need to
educate clinicians on judicious prescribing practices and reduce wide
variation in prescribing patterns for similar patients.

"These are sobering results," said lead study author Michael
Barnett, assistant professor of health policy and management at the
Harvard Chan School and an HMS instructor of medicine at Brigham and
Women's Hospital. "Our analysis suggests that one out of every 48 people
newly prescribed an opioid will become a long term user. That's a big
risk for such a common therapy."

Specifically, the study found that patients who saw frequent, or
so-called high-intensity, opioid prescribers were three times as likely
to receive a prescription for opioids as patients seen by infrequent, or
low-intensity, prescribers in the same hospital.

Individuals treated by the most frequent prescribers were 30%
more likely to become long-term opioid users - defined as receiving six
months worth of pills in the 12 months following the initial
encounter - and were also more likely to have an adverse outcome related
to the drugs, such as a fall, a fracture, respiratory failure or
constipation.

The study also showed that patients treated by low-frequency
prescribers were no more likely to return to the hospital overall or
with the same complaints - findings that suggest these people were not
under-treated for their symptoms.

"Who treats you matters. Our findings lend support to the narrative
that we often hear - a patient happened to be prescribed an opioid by a
dentist or in the emergency room and unwittingly became a long-term
user," said study author Anupam Jena, the Ruth L. Newhouse Associate
Professor of Health Care Policy at HMS and an HMS associate professor of
medicine and physician at Massachusetts General Hospital. "A physician
who prescribes an opioid needs to be conscious that there is a
significant risk that the patient could continue to be on an opioid for
the long term, even from a single, short, initial prescription."

In their analysis, the researchers compared opioid use during 12
months following an initial emergency department encounter among more
than 375,000 Medicare beneficiaries treated by more than 14,000
physicians between 2008 and 2011.

Although the physicians saw patients with similar complaints, they
treated them differently. On the low end of the spectrum, one quarter of
providers gave opioid prescriptions to just 7% of the patients
they saw. At the other extreme, the top quarter of prescribers gave
opioids to 24% of their patients.

"That's an enormous amount of variation just from walking through a
door and getting assigned to one doctor instead of another," said
Barnett.

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